Defining and Validating Criteria to Identify Populations Who May Benefit From Home-Based Primary Care.

BACKGROUND: Home-based primary care (HBPC) is an important care delivery model for high-need older adults. Currently, target patient populations vary across HBPC programs, hindering expansion and large-scale evaluation. OBJECTIVES: Develop and validate criteria that identify appropriate HBPC target populations. RESEARCH DESIGN: A modified Delphi process was used to achieve expert consensus on criteria for identifying HBPC target populations. All criteria were defined and validated using linked data from Medicare claims and the National Health and Aging Trends Study (NHATS) (cohort n=21,727). Construct validation involved assessing demographics and health outcomes/expenditures for selected criteria. SUBJECTS: Delphi panelists (n=29) represented diverse professional perspectives. Criteria were validated on community-dwelling Medicare beneficiaries (age ≥70) enrolled in NHATS. MEASURES: Criteria were selected via Delphi questionnaires. For construct validation, sociodemographic characteristics of Medicare beneficiaries were self-reported in NHATS, and annual health care expenditures and mortality were obtained via linked Medicare claims. RESULTS: Panelists proposed an algorithm of criteria for HBPC target populations that included indicators for serious illness, functional impairment, and social isolation. The algorithms Delphi-selected criteria applied to 16.8% of Medicare beneficiaries. These HBPC target populations had higher annual health care costs [Med (IQR): $10,851 (3316, 31,556) vs.$2830 (913, 9574)] and higher 12-month mortality [15% (95% CI: 14, 17) vs. 5% (95% CI: 4, 5)] compared with the total validation cohort. CONCLUSIONS: We developed and validated an algorithm to define target populations for HBPC, which suggests a need for increased HBPC availability. By enabling objective identification of unmet demands for HBPC access or resources, this algorithm can foster robust evaluation and equitable expansion of HBPC

An Integrated Framework for Infectious Disease Control Using Mathematical Modeling and Deep Learning.

Infectious diseases are a major global public health concern. Precise modeling and prediction methods are essential to develop effective strategies for disease control. However, data imbalance and the presence of noise and intensity inhomogeneity make disease detection more challenging. Goal: In this article, a novel infectious disease pattern prediction system is proposed by integrating deterministic and stochastic model benefits with the benefits of the deep learning model. Results: The combined benefits yield improvement in the performance of solution prediction. Moreover, the objective is also to investigate the influence of time delay on infection rates and rates associated with vaccination. Conclusions: In this proposed framework, at first, the global stability at disease free equilibrium is effectively analysed using Routh-Haurwitz criteria and Lyapunov method, and the endemic equilibrium is analysed using non-linear Volterra integral equations in the infectious disease model. Unlike the existing model, emphasis is given to suggesting a model that is capable of investigating stability while considering the effect of vaccination and migration rate. Next, the influence of vaccination on the rate of infection is effectively predicted using an efficient deep learning model by employing the long-term dependencies in sequential data. Thus making the prediction more accurate

Insights from the numerical analysis of axially loaded piles in liquefiable soils

Axially loaded piles in liquefiable soils can undergo severe settlement due to an earthquake event. During shaking, the settlement is caused by the decreased shaft and tip capacity from excess pore pressures (ue) generated around the pile. Post shaking, soil settlement from the reconsolidation of liquefied soil surrounding the pile results in the development of additional load (known as drag load), causing downdrag settlement of the pile. Estimating the axial load distribution and pile settlement is essential for designing and evaluating the performance of axially loaded piles in liquefiable soils. In practice, a simplified neutral plane solution method is used, where the liquefied soils are modeled as a consolidating layer without considering the effect of ue generation/dissipation. A TzQzLiq analysis models the load and settlement response of axially loaded piles in liquefiable soils by accounting for the effect of excess pore pressure (ue) generation/dissipation on the shaft and tip capacity. This paper presents the deficiencies of the simplified neutral plane method in predicting the drag load as well as the downdrag settlement by comparing it with the TzQzLiq analysis validated with hypergravity model tests. The results show that the drag load and the downdrag settlement predicted by the neutral plane method might be over- or under-estimated depending on the pile load, the rate of ue dissipation, and the soil settlement. For the cases studied, it was found that most of the pile settlement occurs during shaking due to the decrease in the pile's tip resistance from the development of ue in the soil surrounding it. While large drag loads develop during reconsolidation, the resulting downdrag settlement is small. While the neutral plane method generally predicted a downdrag settlement comparable to that of the TzQzLiq analysis, it overpredicted drag load and could not predict co-seismic settlement. Finally, the study advocates for the development and use of a displacement-based procedure (accounting for all the mechanisms occurring during and after an earthquake event) such as based on TzQzLiq analysis in accurately evaluating the performance of the pile (i.e., the pile settlement and the maximum load), thus providing an overall safe, efficient, and optimized design

Stakeholder mapping of precision weeding commercialization ecosystem in California

CONTEXT: Precision weeding, a sector of agricultural technology in which drones and/or automated weeders use chemical, mechanical, or thermal means to eradicate weeds, has moved from academic research settings to commercialization. Because of labor shortage pressures, the push to gain competitive advantages, and the environmental impacts of excessive chemical inputs, many California growers have been interested in adopting precision weeding technologies in their operations. OBJECTIVE: Using semi-structured qualitative interviews, this study investigated the viewpoints of three key stakeholder groups involved in the diffusion and adoption of precision weeding technologies: California growers, precision weeding startups, and agricultural technology venture capital firms. With the supplemental viewpoints of large agricultural firms and their corporate venture capital arms and government agencies, this study seeks to understand the compatible motivations between stakeholders, current collaborative models between stakeholders and their limitations, and the user journey for growers adopting precision weeding technology. METHODS: We conducted 17 semi-structured qualitative interviews with diverse stakeholders in the precision weeding sector to gather textual data and gain high data saturation. Data collection balanced rigorous criteria for participant selection with adaptive interview questions to ensure depth and relevance. The analysis procedure involved coding and thematic framework development, complemented by grounded theory for iterative data examination and stakeholder map creation for distilling cross-organizational insights and stakeholder dynamics. RESULTS AND CONCLUSIONS: The results indicated that compatible motivations include addressing current labor issues, reducing costs, and the potential of precision weeding to transform agriculture. Less cited but still popular motivations included having more weeding options, meeting specific field needs, and environmental sustainability. The individual and stakeholder group cognitive maps demonstrated that concerns such as startup longevity, the high expenses of precision weeding machinery, and some startups lacking a direct connection to growers commonly limit the growers' adoption of precision weeding technologies. SIGNIFICANCE: The procedure and cognitive mapping presented in this study can be applied to other emerging agtech technologies and ecosystems

Hypertension control and risk of age-associated dementia in people with HIV infection.

OBJECTIVE: Hypertension is a major risk factor for dementia, but sustained blood pressure control is difficult to achieve. We evaluated whether inadequately controlled hypertension may contribute to excess dementia risk among people with HIV. DESIGN: A retrospective cohort study. METHODS: We studied demographically matched people with and without HIV between July 1, 2013, and December 31, 2021, who were at least 50 years old and had a hypertension diagnosis but no dementia diagnosis. Hypertension control was calculated using a disease management index (DMI), which captured degree and duration above the hypertension treatment goals of SBP less than 140 mmHg and DBP less than 90 mmHg. DMI values ranged from 0 to 100% (perfect control); hypertension was considered inadequately controlled if DMI was less than 80% (i.e., in control for <80% of the time). Annual, time-updated DMI was calculated for SBP and DBP. Associations of SPB and DPB control with incident dementia were evaluated using extended Cox regression models. RESULTS: The study included 3099 hypertensive people with HIV (mean age: 58.3 years, 90.2% men) and 66 016 people without HIV. Each year of inadequate SBP control was associated with greater dementia risk in both people with HIV (adjusted hazard ratio [aHR] = 1.26, 0.92-1.64) and people without HIV (aHR = 1.27 (1.21-1.33); P- interaction = 0.85). Similarly, inadequate DBP control was associated with greater dementia risk in both people with HIV (aHR = 1.43, 0.90-1.95) and people without HIV (aHR = 1.71, 1.50-1.93; P -interaction = 0.57). CONCLUSION: Findings suggest the association of inadequate hypertension control with greater dementia risk is similar by HIV status. Stronger associations of DBP control with dementia merit further investigation

Ensemble Monte Carlo calculations with five novel moves

We introduce five novel types of Monte Carlo (MC) moves that brings the number of moves of ensemble MC calculations from three to eight. So far such calculations have relied on affine invariant stretch moves that were originally introduced by Christen (2007) [8], walk moves by Goodman and Weare (2010) [16] and quadratic moves by Militzer (2023) [31,32]. Ensemble MC methods have been very popular because they harness information about the fitness landscape from a population of walkers rather than relying on expert knowledge. Here we modified the affine method and employed a simplex of points to set the stretch direction. We adopt the simplex concept to quadratic moves. We also generalize quadratic moves to arbitrary order. Finally, we introduce directed moves that employ the values of the probability density while all other types of moves rely solely on the location of the walkers. We apply all algorithms to the Rosenbrock density in 2 and 20 dimensions and to the ring potential in 12 and 24 dimensions. We evaluate their efficiency by comparing error bars, autocorrelation time, travel time, and the level of cohesion that measures whether any walkers were left behind. Our code is open source

Modulating the behavior of ethyl cellulose-based oleogels: The impact food-grade amphiphilic small molecules on structural, mechanical, and rheological properties

This work evaluates the ability of various lipid-based amphiphilic small molecules (ASMs) to modulate the mechanical and rheological properties of oleogels principally structured by ethyl cellulose (EC). Six ASMs varying in the chemical structure of their polar headgroups were used to produce EC-ASM oleogels. Stearic acid (StAc), monoacylglycerol (MAG), sodium stearoyl lactylate (SSL), and citric acid esters of monoglycerides (CITREM) all provided a dramatic enhancement in gel strength, while lactic acid (LACTEM) and acetic acid (ACETEM) esters produced only a marginal increase. Those additives which crystallized above 20 °C displayed pronounced changes in their network organization and crystal morphology in the presence of EC. Differences in the solid/liquid phase change behavior were also observed in select samples using differential scanning calorimetry. Both the small and large amplitude oscillatory shear responses were dependent on the ASM which was dependent on the chemistry of the headgroup, crystal network organization, and ability to plasticize the polymer network. The extent of thixotropic recovery was largely dependent on the polarity of functional groups in the ASMs, but was also influenced by the formation of a secondary crystal network. In general, ASMs which formed larger, system-spanning crystal networks (MAG, StAc) produced more brittle gels, while the highly hydrophilic, charged headgroup of SSL promoted a homogeneous distribution of small crystals, resulting in a tougher material. In the absence of a crystal network, stronger polar species in the ASM headgroup produced higher gel strength and increased elasticity. Thus, both ASM chemical structure and crystallization properties strongly contribute to the functionality of the resulting combined oleogelator systems

Judgements of identity claims vary for monoracial and biracial people

Abstract: Despite increasing racial diversity in the United States, and the particular growth of multiracial populations, questions about how children perceive others’ (bi)racial identities remain poorly understood. In two preregistered studies, we asked White and racially minoritized American children (N = 157; 4–11‐years old) and White and multiracial adults (N = 226) how acceptable it was for monoracial people (Black or White; Study 1) and/or biracial people (Black–White; Studies 1 and 2) to claim either a monoracial or biracial identity. Consistent with past research with adults, children said that monoracial people should claim (only) the monoracial identity which matched their ancestry. Judgements about biracial identity were more variable. White and multiracial adults (Study 2) reported that biracial targets could claim a racial identity that matched either or both of their parents, with biracial claims being evaluated most positively. Exploratory analyses on children's judgements about biracial people's identity claims (Study 1) revealed different patterns of development for White children and children from minoritized backgrounds. Whereas White children became more likely with age to report that all identity claims were acceptable, children from racially minoritized groups became more likely with age to endorse biracial targets who claimed a biracial identity. These findings suggest that children's own racial background and age may have a larger impact on their perceptions of biracial people's identities, compared to their perceptions of monoracial people's identities

Quality of Life in People With HIV at the End of Life: Preliminary Results From the Last Gift Observational Cohort Study

BackgroundAs people living with HIV (PWH) age, they face new challenges that can have a negative impact on their quality of life (QOL) and mental health.SettingThis study enrolled PWH at the end of life (EOL) who were actively engaged in cure-related research in Southern California, United States. EOL was defined as having a prognosis of 6 months or less to live. We examined the relationship between QOL, mental health, and research participation.MethodsStructured assessments were used to collect comprehensive data on QOL and mental health.ResultsFrom 2017 to 2023, 35 PWH in their final stages of life who were actively engaged in cure-related research were enrolled. Their median age was 62.7 years, and most were White or otherwise non-Hispanic/non-Latino (90.6%), and male (86.7%). Changes in QOL and the presence of neurologic and psychiatric conditions, with a focus on depression and anxiety, were the primary outcomes assessed in this study. Participants had stable QOL scores throughout the study. There was an inverse relationship between QOL and Beck Depression Inventory scores, with higher mean QOL scores being associated with lower mean Beck Depression Inventory scores ( P < 0.001).ConclusionsQOL remained stable among PWH who participate in cure-related research at EOL. The inverse relationship between QOL and depressive symptoms suggests that participation in cure-related research may improve QOL or reduce depressive symptoms in this population. Future interventions should look into ways to improve the well-being of PWH at EOL through research and customized mental health interventions